Mortality and functional impairment after hip fracture - a prospective study in a Portuguese population

Osteoporotic hip fractures (HF) are a major cause of morbidity and mortality with increasing familial, social and economic repercussions. The objectives of this paper were to evaluate the status vitae at 6 and 12 months of a cohort of patients with an osteoporotic HF and the risk factors for 12-month mortality as well as to evaluate the functional outcome and the overall health perception of these patients.

We conducted a 12-month follow-up evaluation of a cohort of 184 patients older than 65 years admitted to our centre with a non-pathological osteoporotic HF from January 1st to December 31st 2007. Baseline data collection was performed in the first 72 hours after admission and, 12 months later, a second evaluation was conducted, by telephone in order to ascertain their status vitae and functional status. The magnitude of sex--specific, age-adjusted associations between potential prognostic factors and mortality was estimated using hazard ratios (HR) and respective 95% confidence intervals (95%CI), calculated using Cox's proportional hazards model.

It was possible to ascertain the status vitae in 164 (89.1%) patients. Overall 12-months mortality was 26.8% (48.3% in males and 22.2% in females). Mortality was higher in patients that became bedridden, were unable to walk again, were admitted to a hospital during the follow-up for any cause and who became dependent in their daily living activities. After discharge, physical therapy and ability to walk again were associated with a lower risk of death. Most of the patients reported a decline of their overall health-related quality of life. More than 75% of patients became totally dependent after HF.

This study reinforces the HF poor outcome. Twelve-month mortality rates were similar to the estimates obtained in other studies, although the 6-month's mortality was higher. Physical deterioration and loss of independence in activities of daily living were evident in this study and constituted major factors for low self-esteem and deterioration of quality of life. Our findings may constitute an evidence for action in this particular population, with an active search for means to improve the outcome of HF in these patients.